An Exploration of Parent Management Training Programs and Their Cultural Relevance

Behavioral parent training is a research-supported treatment for improving child behavior and increasing parenting skills. Despite many programs sharing a theoretical foundation and common elements, there is great variety in terms of treatment targets, populations served, treatment length, delivery setting, and expected outcomes. The purpose of this research was to first systematically organize and categorize relevant program information for the most frequently referenced Parent Management Training (PMT) programs. To this end, 19 programs were identified for review. We summarized each program and their available research evidence which ranged from 1 to 72 studies. The findings from this first project informed the development of the second, which investigated the generalizability and applicability of PMT programs to non-White populations. We learned that the evidence for communities of color was significantly limited because people of color represented a small part of those studied or their information was not presented independently. We conclude that although the behavioral parent training literature for white individuals is robust and varied, this is disproportionately not the case for individuals of color

Uso de la medicina natural y tradicional en cuatro policlínicos pinareños

Introduction: Natural and Traditional Medicine allows professionals to broaden the scientific scope in an integrative way, showing their performance in the health areas of Pinar del Río.Objective: to identify the elements that limits the practice of therapeutic modalities of Natural and Traditional Medicine at primary health care in Pinar del Río municipality.Methods: a descriptive observational study was conducted between May 2016 and July 2017 in the four polyclinics of the municipality of Pinar del Río. The study target group included the doctors and professors of the Basic Work Team (U=1 006). The collection of sample was conducted through cases by authority criteria, and within these by simple random cases, sample (n=234).Results: Comprehensive Medicine Specialists with more than five years of experience predominated, 30.3 % do not applied Natural and Traditional Medicine, 67.9 % considered it useful, 58.8% recognized its effectiveness, phytotherapy prevailed (69.6 %).Conclusion: the application of Natural and Traditional Medicine still demands a priority by the professionals in the primary health care as an alternative to its application, a not minor part expresses not to make use of it, everything indicates that it is an element not to be left to the spontaneity taking care of the scientific and ethical aspects of its necessary prescription as therapeutic modalities.Introducción: la Medicina Natural y Tradicional permite a los profesionales ampliar el horizonte científico de forma integradora, se muestra su desempeño en áreas de salud pinareñas.Objetivo: identificar los elementos que limitan la práctica de modalidades terapéuticas de Medicina Natural y Tradicional en el nivel primario de atención en el municipio Pinar del Río.Métodos: se realizó un estudio observacional, descriptivo, entre mayo 2016 y julio 2017, en los cuatro policlínicos del municipio Pinar del Río. El universo de estudio consideró los médicos y profesores de Grupo Básico de Trabajo (U=1006). La selección de la muestra, se realizó a través de muestreo por criterio de autoridad, y dentro de estos por muestreo simple aleatorio, la muestra (n=234).Resultados: predominaron especialistas de Medicina General Integral con más de cinco años en experiencia, el 30,3% no usa la Medicina Natural y Tradicional, el 67,9% la considera útil, el 58,8% reconoce su efectividad, la modalidad más utilizada fue fitoterapia (69,6 %).Conclusión: el uso de la Medicina Natural y Tradicional aun demanda una prioridad por los profesionales en el nivel primario como alternativa a su uso, una parte no despreciable declararon no la usaban, todo indica que es un elemento a no dejar a la espontaneidad cuidando los aspectos científicos y éticos de su prescripción necesario como modalidades terapéutica

Clinical and cytological characteristics in people with nodular thyroid disease

Introduction: nodular thyroid disease has increased its prevalence in recent years. The cytological study is the cornerstone for decision making in the management of this entity and offers the best predictive value in the pre-surgical assessment. Objective: to describe clinical and cytological characteristics of patients with nodular thyroid disease who underwent fine needle aspiration biopsy (FNAB). Methods:  a descriptive, cross-sectional study comprising the period from January to December of 2016. The target group included 873 people who underwent thyroid FNAB at Abel Santamaría Cuadrado General Teaching Hospital. The cytology records of the Department of P Anatomy were reviewed, collecting the data of all the patients who performed this procedure and the ultrasonographic reports. The variables studied were age, sex, size of the nodule, cytological diagnosis. The data were processed using Microsoft Excel. Frequency distribution tables were made. Results: 90.4 % of the sample corresponded to female gender; 26.6% belonged to the age group between 40 and 49 years, 83.2 % had a nodule between 1 and 1.9cm; 0.9 % of the nodules were diagnosed as malignant. Conclusions: female gender predominated and the age group between 40 and 49 years, the most frequent cytological diagnosis was benign. Thyroid malignancy increased with age

Uso de la medicina natural y tradicional en cuatro policlínicos pinareños

Introduction: Natural and Traditional Medicine allows professionals to broaden the scientific scope in an integrative way, showing their performance in the health areas of Pinar del Río.Objective: to identify the elements that limits the practice of therapeutic modalities of Natural and Traditional Medicine at primary health care in Pinar del Río municipality.Methods: a descriptive observational study was conducted between May 2016 and July 2017 in the four polyclinics of the municipality of Pinar del Río. The study target group included the doctors and professors of the Basic Work Team (U=1 006). The collection of sample was conducted through cases by authority criteria, and within these by simple random cases, sample (n=234).Results: Comprehensive Medicine Specialists with more than five years of experience predominated, 30.3 % do not applied Natural and Traditional Medicine, 67.9 % considered it useful, 58.8% recognized its effectiveness, phytotherapy prevailed (69.6 %).Conclusion: the application of Natural and Traditional Medicine still demands a priority by the professionals in the primary health care as an alternative to its application, a not minor part expresses not to make use of it, everything indicates that it is an element not to be left to the spontaneity taking care of the scientific and ethical aspects of its necessary prescription as therapeutic modalities.Introducción: la Medicina Natural y Tradicional permite a los profesionales ampliar el horizonte científico de forma integradora, se muestra su desempeño en áreas de salud pinareñas.Objetivo: identificar los elementos que limitan la práctica de modalidades terapéuticas de Medicina Natural y Tradicional en el nivel primario de atención en el municipio Pinar del Río.Métodos: se realizó un estudio observacional, descriptivo, entre mayo 2016 y julio 2017, en los cuatro policlínicos del municipio Pinar del Río. El universo de estudio consideró los médicos y profesores de Grupo Básico de Trabajo (U=1006). La selección de la muestra, se realizó a través de muestreo por criterio de autoridad, y dentro de estos por muestreo simple aleatorio, la muestra (n=234).Resultados: predominaron especialistas de Medicina General Integral con más de cinco años en experiencia, el 30,3% no usa la Medicina Natural y Tradicional, el 67,9% la considera útil, el 58,8% reconoce su efectividad, la modalidad más utilizada fue fitoterapia (69,6 %).Conclusión: el uso de la Medicina Natural y Tradicional aun demanda una prioridad por los profesionales en el nivel primario como alternativa a su uso, una parte no despreciable declararon no la usaban, todo indica que es un elemento a no dejar a la espontaneidad cuidando los aspectos científicos y éticos de su prescripción necesario como modalidades terapéutica

Basic educational competences of stomatology professors: their improvement

<strong>Background</strong>: Stomatology professors should master the appropriate educational competences to make the students learn and build their own learning according to contemporary pedagogical trends in Medical Education. <strong>Objective</strong>: To identify the existing deficiencies in professionals´ educational competences. <strong>Method</strong>: Quantitative-qualitative development research in Stomatology career from 2006 to December 2007. This research included 25 professors and the studied variables were: graduation year, experience, educational categorization, pedagogical training and educational competences. Different instruments were applied to professors, students, and directors and a team of experts was formed to work as a nominal group. From the collected data an enabling system of actions was designed. Date was processed using SPSS software version 15.0 for Windows. <strong>Results</strong>: Deficiencies in the development of educational competences were found, negatively influencing educational quality, mainly in the understanding of teaching objectives, and in teaching methods leading to an inappropriate pedagogical investigation. <strong>Conclusions</strong>: Deficiencies in the development of educational competences have an impact on the quality of the future professional. This study is a viable alternative to improve Stomatology professionals in our National Health System.<p> </p

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

BackgroundSparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis.MethodsPROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850.FindingsBetween Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals.InterpretationOver 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function

Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

Background: Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. Methods: PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to 1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein-creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Findings: Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein-creatinine ratio was statistically significantly greater in the sparsentan group (-49·8%) than the irbesartan group (-15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51-0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Interpretation: Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Funding: Travere Therapeutics

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

Background Sparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis. Methods PROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850. Findings Between Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals. Interpretation Over 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function.</p